Form 72-340-10-8-000 - Mississippi Certificate Of Prime Contract Amount Page 2

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Form 72-340-10-8-000 (Rev. 5/10)
Mississippi
Certificate of Prime Contract Amount
Instructions
This form must be typed or printed. Copies or reproductions of the official form are not acceptable.
This form must be signed before a notary public.
1.
The Contractor completes the information under the area labeled 'Contractor Information'.
The Owner completes the information under the area labeled 'Owner Information'. After
2.
completing the information, the owner must sign the form before a notary public.
3.
The Owner can return the completed form either to the Contractor or mail the return to the
Department of Revenue, P.O. Box 1033, Jackson, MS 39215.
4.
If the Owner returns the notarized form to the Contractor, the Contractor should include it
with Form 72-405 Contractor's Application for Material Purchase Certificate and/or Contract
Qualification.

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